Uso de dispositivo de elevação abdominal na coleta de biópsia hepática laparoscópica por LESS: estudo de viabilidade em cadáveres caninos

• Ano de defesa: 2021
• Autor(a) principal: Libardoni, Roberta do Nascimento
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Santa Maria; Brasil; Medicina Veterinária; UFSM; Programa de Pós-Graduação em Medicina Veterinária; Centro de Ciências Rurais
• Palavras-chave em Português: Único portal; Pneumoperitônio; Gasless; Dispositivo de elevação abdominal; Biópsia hepática; Laparoscopia; Single portal; Pneumoperitoneum; Abdominal lifting device; Liver biopsy; Laparoscopy; CNPQ::CIENCIAS AGRARIAS::MEDICINA VETERINARIA
• Link de acesso: http://repositorio.ufsm.br/handle/1/22302

The aim of the present study was to evaluate the viability of the LESS laparoscopic technique (with a single portal), using a mechanical device for lifting the abdominal wall, the multidirectional traction platform (ES201800465 U) and comparing it with low pressure pneumoperitoneum in obtaining of liver biopsy in canine cadavers with respect to certain operational variables. For this purpose, 18 cadavers were used, distributed in three groups, where liver biopsy with a single portal and pneumoperitoneum of 2 mmHg (group G1), 4 mmHg (group G2) and gasless was performed, through the multidirectional traction platform (group G3). The surgical team remained fixed on their function. The dogs were placed in the supine position. All procedures were performed with an 11mm portal, positioned on the 10mm and 0º nephroscope umbilical scar. The weight of the corpses, the total operative time and the times of each stage of the procedures were recorded. The degree of difficulty of surgical access and collection of liver biopsies, as well as the assessment of the intra-abdominal workspace were measured by the surgeon. In addition, two evaluators, proficient in video surgery, and blinded to the type of procedure performed the evaluation of the intra-abdominal videos recorded during the operation and scored according to a pre-established scale on the working space and difficulties in collecting liver biopsies. The fragments of hepatic tissue collected using laparoscopic punch biopsy forceps were weighed on a high precision scale. The average weight of the cadavers selected for the study was 8.7 ± 3.8 kg. The mean total surgical time was longer in the G1 group (30.3 ± 13.5) min, followed by the G3 group (27.3 ± 7.3) min and with a shorter time in the G2 group (24.8 ± 5.3) min (p= 0,6). There was no statistical difference between the groups regarding the quality of the working space, however lower scores were registered for the G1 group, demonstrating that greater viscera manipulation was necessary to reach the target organ. In contrast, the G3 group received higher scores, suggesting an excellent working space, with clear visualization of the target organ and minimal or no manipulation of the viscera. There was a statistical difference in the comparison of biopsy collection between the hepatic lobes, both in the G1 (p = 0.0093), and in the G2 (p = 0.00006) and G3 (p = 0.0053) groups. The right lateral hepatic lobe was considered the most difficult to access to perform the biopsy in our study. The average weight of the samples collected were G1 (96.2 ± 11.58) mg, G2 (90.77 ± 10.57) mg, G3 (87.63 ± 16.42) mg. The liver biopsy technique by LESS using the abdominal elevation device was feasible in canine cadavers and similar to the technique with pneumoperitoneum, representing an alternative to avoid the organic changes associated with the use of pneumoperitoneum.